1. Field of the Invention
The present invention relates to a suction puncture method and a device using the same that samples a tissue or the like as a testing sample from a predetermined part of a body parts or organ to be examined in a living body under the guide of an ultrasonic image, an optical endoscope image, an ultrasonic endoscope image, or the like, in tissue testing or the like of the body part or organ, and more specifically, relates to a suction puncture method and a suction puncture device that can safely collect the tissue or the like of a predetermined part by simple manipulation, and can collect a tissue of any size without crushing the tissue.
2. Description of Related Art
Generally, the method of collecting a tissue or the like from an internal body part or the like that is a target to be examined includes a method of puncturing and collecting the target body part or the like with a collecting needle under the guide of an ultrasonic image, an optical endoscope image, or an ultrasonic endoscope image. For example, the method of performing collection under the guide of an ultrasonic endoscope image performs collection using the collecting needle attached to an endoscope. That is, this method punctures the inside of a target body part or organ with the collecting needle (puncture needle) while specifying a predetermined part on the basis of the projected image by an ultrasonic endoscope, and collects a tissue or the like with this puncture needle.
In the conventional technique, the above collection method includes a so-called suction method (for example, refer to Japanese Unexamined Patent Application, First Publication No. S08-117232) that inserts a puncture needle into a predetermined position (for example, a tumor part or the like) of a target body part or the like, and decompresses the inside of the puncture needle by suctioning using a suction device, such as an injector, and suctions a tissue into the inside of the needle, and a so-called Trucut method (for example, refer to Published Japanese Translation No. 2001-515372 of the PCT International Publication) for pinching a tissue into the puncturing puncture needle.
The puncture needle to be used for the suction method includes an outer tube (51) for collection inserted into an ultrasonic endoscope so as to be able to advance and retreat, and an inner rod (52) inserted into the inside of the outer tube so as to be able to advance and retreat, for example as shown in FIG. 6. The outer tube (51) can be advanced from the front end of that ultrasonic endoscope by manual operation on the base end (external terminal) side of the ultrasonic endoscope. Additionally, the inner rod (52) can be advanced from the front end of the outer tube (51) and can also be extracted and removed from the base end side of the outer tube (51), by manual operation on the base end side of the outer tube (51). Additionally, a suction device, such as an injector, can be attached to the base end side of the outer tube (51), and the inside of the outer tube (51) is brought into negative pressure by manipulating this suction device.
In the suction method, the puncture needle (50) is manipulated as follows.
First, as shown in FIG. 7A, the puncture needle (50) is guided to, for example, the vicinity of a target body part (53) in a state the inner rod (52) is inserted into the outer tube (51) for collection under the guide of the ultrasonic endoscope. At this time, the inner rod (52) is held at a position as closer to the front end portion as possible slightly inward from a front end port of the outer tube (51). The inner rod (52) is provided to prevent tissues other than the target part or the like from entering the outer tube (51) and to avoid contamination caused by mixing of tissues other than the target part as much as possible, when the puncture needle (50) punctures the target body part (53).
Next, as shown in FIG. 7B, for example, a predetermined diseased part of the body part (53) is punctured by the puncture needle (50) in this state. If the puncture needle (50) reaches the predetermined part, tissues (57) other than the target part, such as an alimentary canal mucosa (56) may enter the inside of the front end of the outer tube (51). Thus, as shown in FIG. 7C, the inner rod (52) is pushed out further forward than the tip of the puncture needle (50), and the other tissues (57) accumulated inside the outer tube (51) are discharged.
Next, the inner rod (52) is extracted from the base end side of the outer tube (51), and as shown in FIG. 7D, the suction device (54), such as an injector, is connected to the base end (external terminal) side of the outer tube (51) so as to bring the inside of the outer tube (51) into negative pressure. With this negative pressure being applied, as shown in FIG. 7E, the tip of the puncture needle (50) is advanced and retreated (stroke) 15 to 20 times within the predetermined part of the target body part (53). Thereby, a tissue of the predetermined part is suctioned and collected into the outer tube (51). Thereafter, suction using the negative pressure is released, and the suction device (54) is extracted. Then, as shown in FIG. 7F, the puncture needle (50) is rapidly extracted from the ultrasonic endoscope (55), the collected substance (58) of cells or tissue pieces collected within the outer tube (51) is taken out to a laboratory dish, and is used as a testing sample.
On the other hand, for example, as shown in FIG. 8, a puncture needle (60) to be used for the Trucut method includes an outer tube for collection (62) that is contained within a catheter sheath (61) and formed in the shape of a blade, and an inner needle (63) that is inserted into the outer tube so as to be able to advance and retreat, and a tray portion (64) for containing a sample is recessed in the vicinity of the tip of the inner needle (63).
In the Trucut method, the puncture needle (60) is manipulated as follows.
First, as shown in FIG. 9A, the tray portion (64) of the inner needle (63) is placed in a state where the tray portion comes out of the front end of the outer tube (62) within the catheter sheath (61), and the outer tube (62) and the inner needle (63) are fixed together at a position where the tip of the inner needle (63) does not come out of the front end of the catheter sheath (61). In this state, the puncture needle is guided to the vicinity of the target body part (65). Reference numeral (66) represents organs, such as an alimentary canal mucosa, other than the target body part.
Next, as shown in FIG. 9B, the puncture needle (60) punctures a target part under the guide of the ultrasonic endoscope. Thereby, the tissue of the target part enters the tray portion (64). In this state, as shown in FIG. 9C, with the inner needle (63) being fixed, the outer tube (62) is pushed out to the front end side, a target tissue is cut off by a front end edge of the outer tube, the inner needle (63) is contained within the outer tube (62). Thereafter, as shown in FIG. 9D, the outer tube (62) in which the inner needle (63) is contained is returned to the inside of the catheter sheath (61), the puncture needle (60) is extracted from the ultrasonic endoscope, and the collected tissue (67) is taken out to a laboratory dish from the tray portion (64).